Antenatal - Pre-eclampsia Flashcards
what is pre-eclampsia and when does it occur?
- new high blood pressure in pregnancy with end organ dysfunction - proteinuria
- occurs after 20 weeks gestation when the spiral arteries of the placenta from abnormally which causes high vascular resistance in these vessels
without treatment what can pre-eclampsia cause?
maternal organ damage
fetal growth restriction
seizures
early labour
death
what is the triad of pre-eclampsia?
hypertension
proteinuria
oedema
what is chronic hypertension?
high blood pressure that exists before 20 weeks gestation and is longstanding
NOT caused by dysfunction in the placenta
NOT classed as pre-eclampsia
aim for 140-150/80-90
what is pregnancy-induced hypertension or gestational hypertension?
hypertension occurring after 20 weeks gestation WITHOUT proteinuria
>140/90 or diastolic >110
2 readings 4 hours apart
management of hypertension in pregnancy
aspirin from 12 weeks - 38 weeks
change the meds - labetalol, methyldopa
weekly urine dip, FBC, U&E, LFT, manual BP
4 weekly growth scan from 28 weeks
monitor BP at birth
cant use Ergometrine in HTN
what is eclampsia?
when seizures occur as a result of pre-eclampsia
how are the risk factors for pre eclampsia use to decide whether prophylaxis is required?
- used to determine whether women are offered aspirin
- from 12 week until birth if they have 1 high-risk factor or more than 1 moderate-risk factor
what medication is contraindicated in delivery in hypertension?
Ergometrine
what are the high-risk factors for pre-eclampsia?
- Autoimune
- Before in pregnancy HTN - previous HTN in pregnancy
- CKD
- Diabetes
- Existing HTN
what are the moderate-risk factors for pre-eclampsia?
- older than 40
- BMI >35
- >10 years since previous pregnancy
- multiple pregnancy
- first pregnancy
- family hx of pre-eclampsia
- low pappa
- uterine artery notching
what are the symptoms of pre-eclampsia?
- headache
- visual disturbance or blurriness
- nausea and vomiting
- upper abdominal pain - over liver area from liver swelling (make this clear in exams they know you’re talking about liver pain - epigastric pain can be anything)
- oedema
- reduced urine output
- brisk reflexes
what is the criteria for diagnosis of pre-eclampsia?
- systolic >140 or diastolic >90
PLUS any of
- proteinuria (1+ or more on dipstick)
- organ dysfunction (raised creatinine, elevated liver enzymes, seizures, thrombocytopenia or haemolytic anaemia)
- placental dysfunction (FGR or abnormal Doppler studies
how can proteinuria be quantified?
- urine protein:creatinine ratio (>30mg/mmol is significant)
- urine albumin:creatinine ratio (>8mg/mmol is significant)
what can be used between 20 and 35 weeks gestation to rule-out pre-eclampsia?
placental growth factor (PlGF) which is released by the placenta and functions to stimulate the development of new blood vessels
low in pre-eclampsia
NICE recommend this test on 1 occasion during pregnancy in women suspected of having pre-eclampsia
what are women routinely monitored for at every antenatal appointment for evidence of pre-eclapmsia?
blood pressure
symptoms
urine dipstick for proteinuria
what is the management of gestational hypertension
- treat to aim for a blood pressure below 135/85
- admission for women with blood pressure above 160/110
- urine dipstick weekly
- monitoring of blood weekly (FBC, UE, LFT)
- monitor fetal growth by serial growth scans
- PlGF testing on one occasion
how is pre-eclampsia managed?
- aspirin prophylaxis
- scoring system used to determine whether to admit
- blood pressure monitored closely (every 48 hours)
- urine dipstick testing not routinely necessary as dx already made
- UUS of fetus, amniotic fluid and dopplers performed 2 weekly
what scoring systems can be used for pre-eclapmsia?
fullPIERS
PREP-S
medical management of pre-eclampsia and what are some medications that can be used in pre-eclampsia?
- Labetolol 1st line
- Nifedipine (modified-release) second-line - better response in black population
- Methyldopa third-line (needs to be stopped within two days of birth)
- IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
- Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
what can be used in the critical care setting for severe pre-eclampsia or eclampsia?
Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia
what may be required if there are complications or the blood pressure cannot be controlled?
planned early delivery of the baby
in pre-eclampsia, the blood pressure will return to normal over time once the placenta is removed. what medical treatment can be used after delivery?
- Enalapril 1st line
- nifedipine or amlodipine - first line in black African or Caribbean pt
- Labetalol or atenolol
how are the seizures of eclampsia managed?
IV magnesium sulphate
what is HELLP Syndrome?
combination of features that occurs as a complication of pre-eclampsia
Haemolysis
Elevated Liver enzymes
Low Platelets
what is pre-eclampsia-like syndrome (aka mirror syndrome)
rare complication of severe fetal heart failure
triad of hydrops fetalis, placental oedema and oedema in the mother
also features of hypertension and proteinuria
woman suspected of parvovirus infection need tests for IgM, IgG, and rubella antibodies (as a differential)
